The COVID-AM blog is a partnership between the UMI 3157 iGLOBES and the Institut des Amériques, coordinated by François-Michel Le Tourneau, Deputy Director and Marion Magnan, researcher at the Institute. About the blog.

Livia Kalil currently coordinates the Institut des Amériques' office in Brazil (hosted by USP) and is a doctoral student in Political Science at the University Sorbonne Nouvelle and at the University of São Paulo.

Guilherme Checco is a doctoral student at the University of São Paulo and project coordinator at the Instituto Democracia e Sustentabilidade (IDS).

Upon its return to democracy and the adoption of a new constitution, Brazil, the 9th economy of the world, endowed itself in 1988 with a free, standardized, universal healthcare system (Sistema Único de Saúde – SUS). But despite this, the country is currently facing a number of issues around the fight against Covid-19.

Indeed, besides the confinement, hand washing with water and soap is one of the basic protective measures to avoid the coronavirus contamination. But how can this be done when 35 million Brazilians (14.3 % of the population) do not have access to freshwater (SNIS, 2018 [1])?

The sewage system is another facet of that problem. Even if studies are still being done to check a potential virus contamination in wastewater, notably via feces and other human emissions, recent research in China and Singapore show that liquid effluents, or wasterwater, can be a source of transmission of Sars-CoV-2. Brazil still offers up a harsh reality with over 100 million people (around 47 % of the population) having a tenuous access, if none, to basic sanitation services (SNIS, 2018). Consequently, the most vulnerable category of the population, the one that does not have access to an adequate sanitary insfrastructure, could find itself more at risk of an infection.

From a public health standpoint, especially with the current strain on the hospital system, Brazil's lack of sanitation services also has significant consequences. For example, in 2018 close to 233 000 hospitalizations were due to waterborne diseases —caused by microorganisms present in contaminated or untreated water, such as gastro-intestinal illnesses, leptospirosis, hepatitis A and also bilharzia — (DATASUS, 2018).

Also, Brazil is a federation, organized around three levels of government, the Union, the States and Federal District, and the municipalities. In this system, the last two mainly share the responsability of providing public health services and access to water and sanitation services, the federal governement having more of a role of coordination, specifically by elaborating a national blueprint such as the national sanitation plan (PLANSAB, the first one having been adopted in 2013 following the provisions of law nº 11.445 of 2007 establishing the national sanitation guidelines. 

The services themselves are managed by governmental companies of which about 70 % belong to the States and 25 % to the municipalities (PLANSAB, 2014). However the decision-making arena is divided between the interests of the State and those of the municipalities, making it difficult to reach a consensus on crucial elements in order to expand the sector. These factors played a role during the water supply shortage that the State of São Paulo had to deal with from 2014 to 2016. Though the main reason for the crisis is tied to the recurring droughts, the lack of coordination between the agencies and the subsequent delay in investments have amplified it.

And now, in Brazil overall, the pandemic is again mainly hitting this area. As of April 29, the State of São Paulo has more than 2 000 deaths (40.3 % of the total in Brazil). Most of these deaths are located in the São Paulo municipality, the biggest urban area of Latin America. Since March 24, the residents are asked to respect the confinement put in place by the State's governor João Doria and the mayor of the capital Bruno Covas. And yet, in 2018, close to 120 000 inhabitants had no access to running water at home and close to 460 000 had no access to the city sewage system. And São Paulo is one of the better equiped cities in that domain. Imagine what it is like in the others...

According to the municipal health office of the city of São Paulo, most of the confirmed cases and deaths are far from the city center. On April 27, out of the 1 825 deaths in the city, at least 81 were in the district of Brasilândia, in the North, 77 in the district of Sapopemba, on the East side, then São Mateus (58) and Cidade Tiradentes (51), both also on the East side. Yet, it's on the Nord and East sides of the city that the most disadvantaged neighborhoods are found.

It's also in those neighborhoods that the population has complained about the water supply shortage, even if the Sabesp (the company responsable for the water treatment and distribution in the State of São Paulo) asserts it is not the case. In order to reduce the difficulties of the most vulnerable families, the Paulista government has suspended the payment of water bills for the families who are enrolled in the social tariff, and this until further notice.

Confronted with a scenario of strong water insecurity, Brazil already knew it would not reach the goals it had set of providing universal access to water and sanitation services: Sustainable Development Goal (SDG) 6 for 2030 [2] and national goal established in the Plan for 2033. Despite the plans, indeed, the water security does not appear to be a priority in the public policies of the last few years. If the long-term effects have been felt for quite some time now, these structural difficulties are still visible today because they hinder the fight against Covid-19, putting the disadvantaged population in even greater danger.